Significant numbers of people with post-traumatic stress disorder (PTSD) have diagnosable problems with substance abuse and/or substance addiction. Some of these individuals are addicted to the powerful opioid street drug heroin. In a study published in January 2015 in the journal Drug and Alcohol Dependence, a team of researchers from Australia’s University of New South Wales used a decade-long project to determine if the presence of PTSD alters the course of heroin addiction over extended periods of time. These researchers concluded that the presence of post-traumatic stress disorder creates several unique risks for long-term heroin addicts.
PTSD and Substance Problems
The average person with PTSD is more likely than the general population to get involved with problematic drug or alcohol use, even before developing the disorder, the National Center for PTSD reports. In many cases, affected individuals will ultimately qualify for a diagnosis of substance use disorder. Unfortunately, substance use disorder and post-traumatic stress disorder are comorbid conditions; this means that people affected by both ailments typically have worse overall outcomes than people only affected by substance use disorder or individuals only affected by PTSD. Specific signs of comorbidity in combined cases of PTSD and substance use disorder include reinforcement of the already prominent tendency to avoid any situation that serves as a reminder of a highly traumatic event, worsening of the sleep disruptions that can appear in people with PTSD, worsening of the “down” or negative states of mind associated with PTSD and worsening of the jumpiness and jitteriness (i.e., hypervigilance) associated with PTSD. Doctors can treat overlapping symptoms of PTSD and substance abuse/addiction with options that include medication and a form of change-oriented psychotherapy called cognitive behavioral therapy.
Heroin addiction is the result of lasting changes in the chemical output of a part of the brain called the pleasure center. These changes make a heroin user physically dependent on the drug and also promote a range of functional and behavioral problems that support the continuation of uncontrolled heroin consumption. Under guidelines established in 2013 by the American Psychiatric Association, heroin addiction is just one aspect of a larger condition called opioid use disorder, which includes all diagnosable cases of substance use disorder associated with the consumption of any drug or medication classified as an opioid narcotic. Some people with opioid use disorder only have symptoms of opioid addiction, while others only have symptoms of non-addicted opioid abuse; in addition, some people with the disorder have overlapping or indistinguishable symptoms of addiction and abuse.
PTSD’s Long-Term Impact
In the study published in Drug and Alcohol Dependence, the University of New South Wales researchers used data gathered from a long-term project called the Australian Treatment Outcome Study to assess the impact that post-traumatic stress disorder has on the ongoing course of heroin addiction. The researchers began their work in 2001-2002 with 615 individuals diagnosed with a physical dependence on heroin. Each of these individuals took part in diagnostic interviews that, among other things, allowed the researchers to identify cases of PTSD. A decade later in the years 2011 to 2013, two-thirds (68 percent) of the initial participants underwent a second series of detailed interviews. The researchers found that fully 30 percent of the heroin-addicted study participants met the criteria for a PTSD diagnosis at the time of their original interviews; the lifetime PTSD rate for the participants was an even higher 40 percent. A decade later, just 15 percent of the remaining participants still had diagnosable cases of heroin addiction. The researchers concluded that, in terms of their heroin use or their intake of other substances, those individuals affected by PTSD did not have substantially different long-term outcomes than those individuals unaffected by the disorder. However, they also concluded that the PTSD-affected participants differed from their unaffected counterparts in several important ways. Specifically, the dependent heroin users with PTSD had a higher long-term chance of developing diagnosable symptoms of major depression, a higher long-term chance of trying to commit suicide and a higher rate of long-term unemployment. The study’s authors believe their findings indicate that comorbid PTSD and heroin addiction pose significant, long-term mental and job-related challenges for affected individuals. They also believe their findings underscore the necessity of providing care that adequately deals with the comorbid impact of heroin addiction and PTSD.